Case Report: Explantation of A Binkhorst Iridocapsular Lens >30 Years After Implantation in an Eye With Pseudoexfoliation Syndrome

Abstract

An 86-year-old man with a Binkhorst 2-loop intraocular lens (IOL) that was implanted in the pupillary sphincter 33 years earlier was examined. The pupil of the implanted eye with the Binkhorst IOL was irregular and the eye had pseudoexfoliation (PEX) syndrome. Pupillary erosion resulted from rubbing of the IOL edge against the pupillary sphincter with PEX material. The IOL was removed because of visual distortion and intense pseudophakodonesis. Gross and light microscopic analyses showed no irido-fibro-lenticular adhesions over the lens or fragments of iris tissue attached to the lens. Scanning electron microscopy showed several pores of different sizes. No inflammatory cells were present, suggesting that the IOL was well tolerated.The case suggested that the pupillary ruff was not a good location for implantation of an IOL in an eye with PEX. Caution is recommended before implanting or suturing an IOL close to the pupillary border in eyes with PEX during cataract surgery.

FIGURE 1

Biomicroscopy examination of the right eye shows a quiet anterior chamber, clear transparent cornea, irregular pupil with some iris atrophy, and downward decentration of the Binkhorst 2-loop iridocapsular intraocular lens (IOL). Some pseudoexfoliative material is seen at the pupillary border (green arrows). The inferior haptics drag the pupil down whereas the superior haptics are away from the pupillary border. The superior pupillary area is uncovered as the IOL is progressively decentered downward.

FIGURE 2

The fellow eye (left eye) with an in-the-bag intraocular lens, with pseudoexfoliative material and characteristic radial pattern pigmentation over the optic is seen with a dilated pupil.

FIGURE 3

The implanted intraocular lens completely covers the pupil, which remained square and unresponsive to light. The green arrows indicate the points where the inferior haptics began to erode and change the pupillary size and shape.

FIGURE 4

Phase contrast photomicrographs of the explanted Binkhorst 2-loop intraocular lens (IOL). (A) One of the 2-loop haptic insertions in the transparent optic of the lens is seen (original magnification, ×100). (B) Iris pigment is seen on the surface of the loops (original magnification, ×200). (C) Fibrotic and transparent material adheres to the border of the loops (original magnification, ×200). (D) Collagen material surrounding the iris pigment is seen on the surface of the loops (Congo red, original magnification, ×400).

FIGURE 5

Scanning electron micrograph of the explanted Binkhorst 2-loop intraocular lens (IOL). (A) A fibrillary substance adheres to the haptic of the IOL (×500 magnification). (B) A fibrillary substance adheres to the haptic of the IOL (×2000 magnification). (C) Several holes are seen in the IOL optic (×200 magnification). (D) The sizes of the holes in the IOL optics vary in diameter from 1 to 9 μm (original magnification, ×2000).